Purpose
The objective was to (1) evaluate any recent changes in the United States in the incidences
of medial patellofemoral ligament (MPFL) reconstruction and isolated lateral release
for patellar instability in children and adolescents, (2) identify concomitant procedures
with MPFL, and (3) report national complication rates after MPFL reconstruction with
and without concomitant procedures in children and adolescents.
Methods
A national database was queried for patients aged 5 to 18 years who underwent operative
treatment for patellar instability from 2010 to 2018. Inclusion criteria were either
an MPFL reconstruction or lateral release for a diagnosis of patellar instability.
Concomitant procedures with MPFL reconstruction assessed were tibial tubercle osteotomy,
associated arthroscopic procedures, and lateral release. Changes in incidence in MPFL
reconstruction, lateral release and concomitant procedures were assessed. The following
postoperative complications were assessed: knee stiffness, infection, patella fracture,
and growth arrest or angular deformity.
Results
2,161 patients who underwent MPFL reconstruction and 1,159 patients who underwent
isolated lateral release for patellar instability were identified. The incidence of
MPFL reconstruction in adolescents from 2010 to 2018 did not change significantly
(2010: 7.11, 2018: 5.91, P = .137), while isolated lateral release decreased (2010: 6.06, 2018: 1.83, P < .0001). Concomitant procedures with MPFL reconstruction were common, with arthroscopy
being the most frequent (58-67%). The most common complication within 90 days of surgery
was patella fracture (0.4% to 2.0%). Infection (0.4% to 1.0%) and growth arrest (0.09%
to 0.61%) were the least common. MPFL and arthroscopy had a decreased risk of growth
arrest following surgery compared to MPFL alone (P = .038).
Conclusions
The incidence of MPFL reconstruction remained high from 2010 to 2018, while isolated
lateral release decreased during the same time period. Complications after MPFL reconstruction,
isolated lateral release, and concomitant procedures were infrequent, with postoperative
patella fracture the most common.
Level of Evidence
IV, case series
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Article Info
Publication History
Published online: June 11, 2021
Accepted:
May 29,
2021
Received:
February 6,
2021
See commentary on page 474Footnotes
The authors report the following potential conflicts of interest or sources of funding: B. C. Werner reports grants and fees from Arthrex, grants from Blomet, Exatech, and Flexion Therapeutics, outside the submitted work. D. R. Diduch reports grants from Aesculap and Moximed, as well as personal fees from Depuy Mitek, Osteocentric, and Smith and Nephew, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2021 by the Arthroscopy Association of North America
